Provider Demographics
NPI:1215468798
Name:INTEGRACARE INC
Entity type:Organization
Organization Name:INTEGRACARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER & OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-338-0837
Mailing Address - Street 1:2920 HARRISON AVE NW
Mailing Address - Street 2:SUITE B
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-2604
Mailing Address - Country:US
Mailing Address - Phone:360-338-0837
Mailing Address - Fax:360-705-9052
Practice Address - Street 1:2920 HARRISON AVE NW
Practice Address - Street 2:SUITE B
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2604
Practice Address - Country:US
Practice Address - Phone:360-338-0837
Practice Address - Fax:360-705-9052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-25
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIHS.FS.60384083251E00000X, 251J00000X, 253Z00000X, 347C00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
253Z00000XOtherTAXONOMY NUMBER
347C00000XOtherTAXONOMY NUMBER
374U00000XOtherTAXONOMY NUMBER
251E00000XOtherTAXONOMY NUMBER
372500000XOtherTAXONOMY NUMBER
172A00000XOtherTAXONOMY NUMBER
3747A0650AOtherTAXONOMY NUMBER
3747P1801XOtherTAXONOMY NUMBER
376K00000XOtherTAXONOMY NUMBER
372600000XOtherTAXONOMY NUMBER
3765J00000XOtherTAXONOMY NUMBER